Provider Demographics
NPI:1427854751
Name:AMY ABSALONSON PLAY THERAPY AND COUNSELING
Entity type:Organization
Organization Name:AMY ABSALONSON PLAY THERAPY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABSALONSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-502-8126
Mailing Address - Street 1:1857 N ARONMINK WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1162
Mailing Address - Country:US
Mailing Address - Phone:208-860-4452
Mailing Address - Fax:
Practice Address - Street 1:6428 W. INTERCHANGE LANE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8370
Practice Address - Country:US
Practice Address - Phone:208-502-8126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)